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General NPI Number Information
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NPI Number | 1912420134
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Entity Type | Individual
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Provider Name | STEPHANIE KRISTAL MA, CH
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Gender | Female
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 275 FAIR ST STE 30
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City | KINGSTON
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State | NY
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Zip | 12401-3882
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Country | US
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Telephone | 845-750-4438
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Fax | 845-687-6249
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Provider Business Mailing Address
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Address Line | 686 BERME RD
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City | HIGH FALLS
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State | NY
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Zip | 12440-5526
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Country | US
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Telephone | 845-750-4438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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